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Benchmarking health system performance across states in Nigeria: a systematic analysis of levels and trends in key maternal and child health interventions and outcomes, 2000-2013.

Wollum A, Burstein R, Fullman N, Dwyer-Lindgren L, Gakidou E - BMC Med (2015)

Bottom Line: Under-5 mortality decreased in all states from 2000 to 2013, but a large gap remained across them.We found that Nigeria made notable gains for a subset of MCH indicators between 2000 and 2013, but also experienced stalled progress and even declines for others.Subnational benchmarking ought to occur regularly in Nigeria and throughout sub-Saharan Africa to inform local decision-making and bolster health system performance.

View Article: PubMed Central - PubMed

Affiliation: Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave, Suite 600, Seattle, WA, 98121, USA. awollum@uw.edu.

ABSTRACT

Background: Nigeria has made notable gains in improving childhood survival but the country still accounts for a large portion of the world's overall disease burden, particularly among women and children. To date, no systematic analyses have comprehensively assessed trends for health outcomes and interventions across states in Nigeria.

Methods: We extracted data from 19 surveys to generate estimates for 20 key maternal and child health (MCH) interventions and outcomes for 36 states and the Federal Capital Territory from 2000 to 2013. Source-specific estimates were generated for each indicator, after which a two-step statistical model was applied using a mixed-effects model followed by Gaussian process regression to produce state-level trends. National estimates were calculated by population-weighting state values.

Results: Under-5 mortality decreased in all states from 2000 to 2013, but a large gap remained across them. Malaria intervention coverage stayed low despite increases between 2009 and 2013, largely driven by rising rates of insecticide-treated net ownership. Overall, vaccination coverage improved, with notable increases in the coverage of three-dose oral polio vaccine. Nevertheless, immunization coverage remained low for most vaccines, including measles. Coverage of other MCH interventions, such as antenatal care and skilled birth attendance, generally stagnated and even declined in many states, and the range between the lowest- and highest-performing states remained wide in 2013. Countrywide, a measure of overall intervention coverage increased from 33% in 2000 to 47% in 2013 with considerable variation across states, ranging from 21% in Sokoto to 66% in Ekiti.

Conclusions: We found that Nigeria made notable gains for a subset of MCH indicators between 2000 and 2013, but also experienced stalled progress and even declines for others. Despite progress for a subset of indicators, Nigeria's absolute levels of intervention coverage remained quite low. As Nigeria rolls out its National Health Bill and seeks to strengthen its delivery of health services, continued monitoring of local health trends will help policymakers track successes and promptly address challenges as they arise. Subnational benchmarking ought to occur regularly in Nigeria and throughout sub-Saharan Africa to inform local decision-making and bolster health system performance.

No MeSH data available.


Related in: MedlinePlus

Changes in OPV3 and DPT3 immunization coverage by state from 2000 to 2013
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Fig5: Changes in OPV3 and DPT3 immunization coverage by state from 2000 to 2013

Mentions: State-level trends in coverage for DPT3 and OPV3, both vaccines with similar dosing requirements and immunization schedules [54, 55], were particularly heterogeneous. Figure 5 shows coverage rates of DPT3 and OPV3 for every state, grouped by geopolitical zone, for 2000 and 2013. Increases in OPV3 coverage were particularly pronounced for several states in North West and North East, which traditionally have been high-priority targets for Nigeria’s polio elimination campaigns [56]. Increased DPT3 coverage lagged behind the gains recorded for the receipt of OPV3. For instance, in Kebbi and Katsina, the difference between coverage of OPV3 and DPT3 exceeded 50 percentage points. By contrast, many states in the North Central and South South zones recorded similar increases in OPV3 and DPT3 coverage over time. In a number of southern states, DPT3 immunization coverage exceeded OPV3 vaccination rates. In Lagos state, DPT3 coverage was 19 percentage points higher than OPV3 coverage, with 88% DPT3 coverage (95% CI, 76–94%) and 69% OPV3 coverage (95% CI, 48–83%). Further, state-level differences in coverage varied for these two vaccines. In 2013, DPT3 immunization rates spanned from 3% in Sokoto (95% CI, 1–9%) to 88% in Ekiti (95% CI, 78–94%) and 88% in Lagos (95% CI, 76–94%). Conversely, the gap narrowed between states with the highest and lowest levels of OPV3 coverage over time, decreasing from a difference of 59 percentage points in 2000 and 33 percentage points in 2013.Fig. 5


Benchmarking health system performance across states in Nigeria: a systematic analysis of levels and trends in key maternal and child health interventions and outcomes, 2000-2013.

Wollum A, Burstein R, Fullman N, Dwyer-Lindgren L, Gakidou E - BMC Med (2015)

Changes in OPV3 and DPT3 immunization coverage by state from 2000 to 2013
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4557921&req=5

Fig5: Changes in OPV3 and DPT3 immunization coverage by state from 2000 to 2013
Mentions: State-level trends in coverage for DPT3 and OPV3, both vaccines with similar dosing requirements and immunization schedules [54, 55], were particularly heterogeneous. Figure 5 shows coverage rates of DPT3 and OPV3 for every state, grouped by geopolitical zone, for 2000 and 2013. Increases in OPV3 coverage were particularly pronounced for several states in North West and North East, which traditionally have been high-priority targets for Nigeria’s polio elimination campaigns [56]. Increased DPT3 coverage lagged behind the gains recorded for the receipt of OPV3. For instance, in Kebbi and Katsina, the difference between coverage of OPV3 and DPT3 exceeded 50 percentage points. By contrast, many states in the North Central and South South zones recorded similar increases in OPV3 and DPT3 coverage over time. In a number of southern states, DPT3 immunization coverage exceeded OPV3 vaccination rates. In Lagos state, DPT3 coverage was 19 percentage points higher than OPV3 coverage, with 88% DPT3 coverage (95% CI, 76–94%) and 69% OPV3 coverage (95% CI, 48–83%). Further, state-level differences in coverage varied for these two vaccines. In 2013, DPT3 immunization rates spanned from 3% in Sokoto (95% CI, 1–9%) to 88% in Ekiti (95% CI, 78–94%) and 88% in Lagos (95% CI, 76–94%). Conversely, the gap narrowed between states with the highest and lowest levels of OPV3 coverage over time, decreasing from a difference of 59 percentage points in 2000 and 33 percentage points in 2013.Fig. 5

Bottom Line: Under-5 mortality decreased in all states from 2000 to 2013, but a large gap remained across them.We found that Nigeria made notable gains for a subset of MCH indicators between 2000 and 2013, but also experienced stalled progress and even declines for others.Subnational benchmarking ought to occur regularly in Nigeria and throughout sub-Saharan Africa to inform local decision-making and bolster health system performance.

View Article: PubMed Central - PubMed

Affiliation: Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave, Suite 600, Seattle, WA, 98121, USA. awollum@uw.edu.

ABSTRACT

Background: Nigeria has made notable gains in improving childhood survival but the country still accounts for a large portion of the world's overall disease burden, particularly among women and children. To date, no systematic analyses have comprehensively assessed trends for health outcomes and interventions across states in Nigeria.

Methods: We extracted data from 19 surveys to generate estimates for 20 key maternal and child health (MCH) interventions and outcomes for 36 states and the Federal Capital Territory from 2000 to 2013. Source-specific estimates were generated for each indicator, after which a two-step statistical model was applied using a mixed-effects model followed by Gaussian process regression to produce state-level trends. National estimates were calculated by population-weighting state values.

Results: Under-5 mortality decreased in all states from 2000 to 2013, but a large gap remained across them. Malaria intervention coverage stayed low despite increases between 2009 and 2013, largely driven by rising rates of insecticide-treated net ownership. Overall, vaccination coverage improved, with notable increases in the coverage of three-dose oral polio vaccine. Nevertheless, immunization coverage remained low for most vaccines, including measles. Coverage of other MCH interventions, such as antenatal care and skilled birth attendance, generally stagnated and even declined in many states, and the range between the lowest- and highest-performing states remained wide in 2013. Countrywide, a measure of overall intervention coverage increased from 33% in 2000 to 47% in 2013 with considerable variation across states, ranging from 21% in Sokoto to 66% in Ekiti.

Conclusions: We found that Nigeria made notable gains for a subset of MCH indicators between 2000 and 2013, but also experienced stalled progress and even declines for others. Despite progress for a subset of indicators, Nigeria's absolute levels of intervention coverage remained quite low. As Nigeria rolls out its National Health Bill and seeks to strengthen its delivery of health services, continued monitoring of local health trends will help policymakers track successes and promptly address challenges as they arise. Subnational benchmarking ought to occur regularly in Nigeria and throughout sub-Saharan Africa to inform local decision-making and bolster health system performance.

No MeSH data available.


Related in: MedlinePlus